Prostate Cancer

Causes

Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.

Risk Factors

Prostate cancer is more common in men who are aged 55 years and older. It is also more common in black men than white men. Other factors that may increase your chance of prostate cancer include:

Family history of prostate cancer, especially father or brother

Family history of prostate cancer diagnosed at a young age

A high-fat diet

Symptoms

Prostate cancer may cause:

A need to urinate frequently, especially at night

Difficulty starting urination or holding back urine

Not able to urinate

Weak or interrupted urine flow

Painful or burning urination

Difficulty having an erection

Painful ejaculation

Blood in urine or semen

Frequent pain or stiffness in the lower back, hips, or upper thighs

These symptoms may be caused by other conditions, such as
benign prostatic hyperplasia (BPH)
or an infection. If you have any of these symptoms, promptly see your doctor.

Diagnosis

Your doctor will ask about symptoms and medical history. A physical exam will also be done.

Tests may include:

Digital rectal exam

Blood tests

Urine tests

Imaging tests evaluate the prostate and surrounding structures. These may include:

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, prostate cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment

Cancer treatment varies depending on the stage of prostate cancer. You and your doctor will discuss the best treatment options for you. Treatment may include:

Watchful Waiting

This involves your doctor monitoring the cancer to see if it is growing. Watchful waiting may be appropriate if you:

Have early stage prostate cancer that is growing slowly

Are of an advanced age

Have serious health problems (risks of treatment outweigh the benefits)

Surgery

Types of surgery that may be needed include:

Pelvic lymphadenectomy—removal of lymph nodes in the pelvis to determine if they contain cancer

Radiation Therapy

Radiation therapy
involves the use of radiation to kill cancer cells and shrink tumors. Examples include:

Conformal radiation therapy—conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.

Intensity-modulated radiation therapy (IMRT)—
IMRT
uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.

Hormone Therapy

If prostate cancer has spread or has returned after being treated, hormone therapy may be used. The goal of hormone therapy is to lower the levels of male hormones, called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancer to shrink or slow its growth.

Hormone therapy may include:

Luteinizing hormone-releasing hormone (LHRH) analogs

Luteinizing hormone-releasing hormone (LHRH) antagonists

Anti-androgens

Estrogen therapy—rarely used now unless other treatments are not working

Antifungal medications

Antineoplastic agents

In some case, a type of surgery called orchiectomy may be needed. This involves removing the testicles, which stops androgens from being produced.

Other Treatment Options

Other options may include:

Cryosurgery—this involves using an instrument to freeze and destroy prostate cancer cells

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